Medicaid Reform Managed Care Study . Interim Update. May 2013. Study Background. SEA0082 passed by Wyoming Legislature (2013) Requires WDH to explore the use of managed care for the Medicaid population
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Requires WDH to explore the use of managed care for the Medicaid population
“The department shall explore the use of managed care for all or a designated part of the Medicaid population, with the goal of delivering care of the same or better quality as currently delivered but at reduced cost. The managed care plan shall include identification of goals, outcome measurements and evaluation tools...”
Ensures that enrollees have a primary care provider who receives a small monthly per capita payment (an administrative fee) to coordinate each enrollee’s care. All services are still paid on a fee-for-service basis.
Typically covers a single type of benefit, paid on a capitated basis.
Comprehensive risk-based managed care
Typically incorporates a health maintenance organization (HMO) model in which enrollees must use a network of providers. States pay on a capitated basis.